03050102 : CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'yCONTRACTOR INFORMATION �, .
K
BUILDING ADDRESS: ALL SEASONS ROOFING SERVIC F" "D03050102
OWNER'S NAME: 2640 PACER LN PERMn"SS69A7 L 2/2003
kj,
TTY CONANq
"E' 4089724455 SANITARY NO. / CONTROL NO.
ARCHITECT7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l�
.Op LICENSED CONTRdunderSDEsionof hap JobDescri tion
uC ON
1 hereby affirm that 1 an fi Bu under provisions of ch . 9(commencing p
2�W with Section? ) fDivtsion3of NCB Profevdoiu Code.and mylicusvcu
j�?n- in rues Tone to ec —titin(� Ql REROOF
Licens Clu 9 Lp.p
e£G Daic 1 nlandmyplansmal be pauR2ct°d JUL 3 0 2003
y>U
eta.�' Licensed Professional
.O OWNER-BUILDER BUILDING
00 1 hereby a0irm Na 1 am exempt tram the Contractors License Law for the
0 O following mnson.(Section 7(31.5,Business and Profesviuu Code:Any city dr county
$ which requires a permit m construct,ahr.improve,demolish,in repair any structure
-Zy prior 0 its issuance,also requires the applicant for such Permit o file a signed statement
Civ Nat he is licensed pursuant tothcprovisions ofthcContractor's LisnscLaw(Chapter 9 Sq.Ft.Floor Area $BN��4ion
�I-a (commencing with Section 7(X0)of Division 3 of the Business and Professinu Code)or
$ that he Is exempt themfrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of hundred not more than 3�� �ygeT O O Occupancy e
fin (5500). p y Typ
❑1,u owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended of offered for sale(Sec.70th,Business .3105 - FRAME
and Professions Cade:The Contractors License Law does not apply in an owner of Re aired Inspections
propeny who builds orimpmvesthereogand whodonasuchwmthimselfor0uough his 307 - INSULATlq ON
own employers,provided that such improvements are not intended oronmed for sale.If. 6O1 - ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the ownv-
wader will nave one huraat of proving that the did non build or improve tar pamase of 602 — ROOF PLYWOOD NAIL
ask.).
O 1.as owner of the properr,am exclusively contracting with IlccvW eontracmn to 603 - ROOF BATTENS
construct the project(Sec.70as,Business and Professions Code:)The Conmcprs Li- 604 - ROOF IN-PROGRESS
cense Law does not apply in an owner of property,who builds or improves thereon,and
who contracts for such projccss with•c.wmm(s)licensed pursuant to the Comeattara
License law.
1 em exempt under Sec. .B&P C for this Oman
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby grim under penalty of perjury,ane of the fallowing declarations:
I nominal will maintain a CeniGnte of Consent the aelf-iomm for Workers Campion.
7371W
a.u provided for by Section 37W of the labor Code,for the performance of the
k for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u requited by Section
or the labor Code,for the performance of the work for which this permit is issuednt orkc� penation lysurana kvv, Pan N�murbor am:
I
CERTIF7G(TE-OF E%EMPTI0N FR ERS'
COMPENSATION INSURANCE
(Btu sects.need not be complee0 if the permit is for..hundmddollamn)(10)
or less.)
I unify dtat in the perfomunee of the work for which this Permit Is issued.l shall not
employ any poison in any m.nerw u to become subject to the Workers Compensation
Laws of califamia.Data
Applicant
NOTICE TO APPLICANT:If,otter making this Certificate of Exemption,you should
Werra subject re the WOdmrb Compensation provisions of the Latour Code,you mus
.J.z forthwith comply with such provisions or this permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
r
O~ Ile,which
that there issued(ol.constructionlending .) for the performance of
W theLe work(m which Nu permit is issued(Sec.709'!,Civ.C.)
fA 0 lender's Name
M LCnderi Address
U Z
U Q I cavity that 1 haves rad this application and soot that the above information
u
0 U building
1 agRr m comply n,and with all City Nd county oNtives of and State efts"prelatingt 1n
V buon-acoutrucoialony hereby authonreo:pmsenuti esof this city menmrupon the
awve-mcntio.d property for iupeNony keep hs
(We)agree to save,indemnify and keep harmless the City of Cupertino d City
h liabilincoises,judgmcnu,ensuing expenses which may in any way same againsl.said City l
t.)aZ in conscque.c of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S CE REGU TIONS.
_ S- 'o Re-roofs
tgn arc o A h HAZARDOUS MATERIALS DISCLOSURE Consimur Dae Type of Roof
Will the.,pliant Cr forum building occupant Rom or handle heOmdous material
u&flood by the Copiers.Municipal Code.Chapter 9.13.and the Health and Safety
mrd.Seen.zss3z(a)7 - All roofs shall be inspected nor to an roofing material being Yes "a P P Y S g installed.
Will the applicant or future building Occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air cunuminsnu u dcfned by th Bay Area Air Quality Management all new materials for inspection.
District? /^
❑Yes g7 Nu
1havemadthe harardGpsmatenalsmquiscmenssunder Chrstood 95ofthe Caldiii,
Iia Health&Safetyba .rearaL shat 05,Iti25533 Myonfd255Ja.l undotify thoicup Wilding //
Jou net curendy hove•¢Want that it u my mxponsibiliry p notify the occupant of the
retrim guwh'hmys cram poor or issuance of a Certificate of Occupancy. ' nature Of Applicant - Date
owner or amorira gem o All roof coverings to be Class B or better
.... ................................................................................................................................................................... 0.2,/OO.................
O5/21/Oa 14:1a '$408777aaaa CITY CUPERTINO fm 002a
Community Development Department
Building Division
OCITYF
City of Cupertino
10300 Torre Avenue777322Telephone: (408) 8
Fax: (408)7773333
CUPS TINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
• 3) Final inspection approval.
a) Spark arrester installation.
S. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V4"per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply,with
the above stated policy on re-roofing.
Homeowners Name: 7��U�ril
Job Site Address: J /ll lahnl9, • , ��/ �U - ,, , n
Roofing Company Nam �J ea sOn,5 OQ I W ILC—
A plicant's Signature: Date: n d3
V1I461J1►Dt
Greg eel
Building Official
Revised 1/30/03
Pdnted en Recycled Paper
2
r................................................................................................................................................................�.......001/005...................
06/21/05 14:12 '$4087775555 CITY CUPERTINO
CITY OF CUPERTINO O
REROOF
CU*PEP,, PERMIT APPLICATION FORM
APN# — /^�� Date ,
Bu !/ddr
ildingTO n r oL- CJS Gt c� /
�r'�� 9S�/
O er's e: Phone#:
as 7- 9,r&,�2
ct Phone#• License#:
r� C n 7/ -4/�� S 469
Coptactl Phone#: Cupertino B siness License#:
ar z° �erz ez cvo9 9-7/- WS a � X35
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles CW Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
�Nprnber of existing coverings e;9, ❑ Provide I.C.B.O.Report#
17p To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: Ti✓ R OF — a,/ a e ✓t 9 2 v p S /S 7
eyr-
h l� Gd t2 J
Residential. Commercial ❑
Fire Zane: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LU
Cost of Type of Con wcsion: Occupancy group:
Qty• ' r
A 1• a e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit FeesBUILDING
BENERGY Ener BUILDING
BSBISMICRE Seismic Fee Res J33VILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUII,DING
1